Laparoscopic splenectomy is a safe feasible operation in patients with spleen injury. The operation is indicated in patients with spleen laceration >3 cm of parenchymal depth with moderate continuing bleeding or expanding hematoma and contraindicated in patients with hemodynamic instability and high bleeding rate (>500 mL/h on serial ultrasound examinations).
Clinical and morphological comparison of wound healing after transplantation of living cultured allofibroblast on days 1-2 after the injury, collagen-1-based dressing with PDGF-BB, and traditional dressing with levomecol ointment showed that bioactive dressing accelerated wound epithelialization (5-7 days vs. 20-22 days with gauze dressing); the incidence of suppurative complications decreased, no crust formed, and epithelialization was not associated with the formation of a hypertrophic cicatrix. Biological dressing based on living cultured allofibroblasts and collagen-1 with PDGF-BB exhibited equal stimulatory effects on burn wound healing.
Несмотря на появление новых миниинвазивных хирургических технологий, шовных материалов, сетчатых эндопротезов (биологические, 3D-сетки), по данным российских хирургов В.И. Белоконева, А.С. Ермолова, В.Н. Егиева, в структуре всех хирургических вмешательств доля лапаротомий, выполняющихся в экстренной и плановой хирургии, остается высокой и составляет от 2 до 52% [13-15]. Развитие трансплантации органов и тканей оказывает влияние на увеличение частоты послеоперационных грыж. Так, в недавно опубликованном проспективном исследовании, включающем 140 пациентов, B. de Goede и соавт. [16] отметили, что у 43% из них, которым была выполнена трансплантация печени, в отдаленном послеоперационном периоде (36 мес) была диагностирована грыжа. Нерешенной проблемой остается высокий риск развития этого осложнения в онкологической колопроктологии. Y. Maestre и соавт. [17] ретроспективно и проспектив-ОБЗОРЫ
The main principles of treatment of external postoperative pancreatic fistulas are viewed in the article. Pancreatic trauma was the reason of pancreatic fistula in 38.7% of the cases, operations because of acute pancreatitis - in 25.8%, and pancreatic pseudocyst drainage - in 35.5%. 93 patients recovered after the treatment. Complex conservative treatment of EPF allowed to close fistulas in 74.2% of the patients with normal patency of the main pancreatic duct (MPD). The usage of octreotide 600-900 mcg daily for at least 5 days to decrease pancreatic secretion was an important part of the conservative treatment. Endoscopic papillotomy was performed in patients with major duodenal papilla obstruction and interruption of transporting of pancreatic secretion to duodenum. Stent of the main pancreatic duct was indicated in patients with extended pancreatic duct stenosis to normalize transport of pancreatic secretion to duodenum. Surgical formation of anastomosis between distal part of the main pancreatic duct and gastro-intestinal tract was carried out when it was impossible to fulfill endoscopic stenting of pancreatic duct either because of its interruption and diastasis between its ends, or in the cases of unsuccessful conservative treatment of external pancreatic fistula caused by drainage of pseudocyst.
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